脑动静脉畸形导致出血的多层螺旋CT血管造影的相关因素分析

目的 探讨多层螺旋CT血管成像(MSCTA)显示脑动静脉畸形(AVM)合并出血的影像学相关因素.方法 通过比较脑AVM出血组和未出血组之间MSCTA所显示的供血动脉、畸形血管团、引流静脉特点.结果 脑出血组与未出血组两组间MSCTA所显示得畸形血管团部位、大小、引流静脉条数、引流静脉是否受损以及有无合并动脉瘤比率差异有统计学意义.结论 MSCTA提示导致AVM的血管压力增高的深部位、小病灶、单支引流静脉或引流静脉狭窄、闭塞以及合并动脉瘤是脑AVM合并出血的密切相关因素.MSCTA为临床治疗提供依据和借鉴.     

脑动静脉畸形并出血的显微手术治疗

目的 回顾性分析78例脑动静脉畸形（AVM）并出血的显微外科手术治疗结果，探讨AVM并出血的显微手术技巧及适应证。方法 所有病例术前均接受CT检查，术后均接受CT及MRI检查，其中25例接受了DSA检查。所有病例均在全麻状态下进行显微外科手术治疗，少部分AVM未能全切的病例，术后用γ-刀或血管内介入治疗。结果 血肿全清除69例，大部分清除9例；AVM全切除70例，8例部分切除或未能切除，加用γ-刀或血管内介入治疗。手术后死亡6例（8．0％），偏瘫4例（5．1％），失语2例（2．6％），偏盲1例（1．3％），脑神经功能障碍4例（5．1％），无颅内感染。结论 应用显微外科手术治疗脑AVM并出血安全有效，而且并发症、后遗症较少，应成为脑AVM并出血患者治疗的最佳选择，对特殊位置的AVM，不宜强行切除，手术时只作血肿清除，术后加用γ-刀或血管内介入治疗。     

脑动静脉畸形出血的危险因素

目的探讨脑动静脉畸形(BAVM)出血的危险因素。方法收集DSA确诊的BAVM患者105例,分析BAVM出血的危险因素。结果单因素分析表明,BAVM破裂出血的危险因素有病灶位置、大小,供血动脉类型、数目,引流静脉类型、数目、形态及是否合并动静脉瘘;多因素Logistic分析发现,病灶位置、大小,供血动脉类型、数目,引流静脉数目及是否合并动静脉瘘是出血的危险因素,而引流静脉扩张可能是保护因素。结论病灶位于幕下或大脑深部、畸形团3cm、单支静脉引流、单纯穿支动脉供血及多支供血动脉、合并动静脉瘘是BAVM出血的危险因素。     

脑动静脉畸形团血管影像学特点

目的探讨脑动静脉畸形团的形态学特点。方法回顾性分析69例脑动静脉畸形脑血管造影影像资料。结果脑动静脉畸形团多表现为幕上、致密、类椭圆或不规则形，呈多支动脉的区域性供血，可伴有动脉瘤或动静脉瘘。结论脑动静脉畸形团形态存在多样性，结构复杂，其内部形态与临床症状与预后密切相关。     

脑动静脉畸形出血的急诊手术

目的 探讨CTA对脑动静脉畸形出血急诊手术的意义. 方法 回顾性分析脑动静脉畸形出血急诊手术患者15例的临床资料,术前均行脑血管3D-CTA检查,根据CTA结果行手术治疗. 结果 全组患者术前3D-CTA检查均提示脑动静脉畸形,入院后急诊行开颅血肿清除及脑动静脉畸形切除术.术后死亡1例,植物状态生存2例,轻残2例,其余恢复良好.术后DSA检查12例,脑动静脉畸形全切除9例,1例行主要供血动脉阻断,未行畸形血管切除,2例有脑动静脉畸形部分残留后行伽马刀治疗. 结论 脑动静脉畸形出血急诊手术清除血肿及切除畸形血管是首选治疗方法,术前3D-CTA检查对手术有重要意义.     

CTA、MRA诊断脑动静脉畸形:与DSA比较

目的比较CTA、MRA与DSA对脑动静脉畸形（AVM）的诊断价值。方法回顾性分析经DSA确诊为脑AVM的48例患者的脑CTA及MRA图像,并统计其诊断效率。结果27例患者接受颅脑CTA检查,7例大型脑AVM（直径〉6cm）与DSA结果一致,12例中型脑AVM（直径3-6cm）中1例CTA未检出,8例小型脑AVM（直径〈3cm）中CTA漏诊3例,CTA与DSA检查结果的差异有统计学意义（P〈0．05）。对21例患者行MRA检查,其中14例大、中型脑AVM（直径≥3cm）MRA诊断结果与DSA一致,7例小型脑AVM（直径〈3cm）中MRA漏诊4例,与DSA检查结果的差异有统计学意义（P〈0．05）。结论CTA、MRA诊断大、中型脑AVM与DSA基本相符,而对于小型脑AVM的诊断效率较低。     

ONYX栓塞脑动静脉畸形八例临床分析

目的 介绍应用新型液态栓塞剂ONYX栓塞脑动静脉畸形的临床经验和疗效.方法 8例脑动静脉畸形患者均采用Seldinger技术在股动脉内置入6F鞘,6F导引导管进入颈内动脉或椎动脉,Ultraflow微导管超选择进入畸形团内,采用"阻断和前推技术"长时间缓慢注射ONYX栓塞脑动静脉畸形.结果 治疗后脑动静脉畸形的体积缩小为40%～100%,其中1例患者达到影像学完全栓塞,1例患者出现偏瘫,其余无严重并发症.结论 ONYX可提高脑动静脉畸形的栓塞效果,但单纯栓塞的长期疗效有待随访.     

脑动静脉畸形伴发动脉瘤的出血风险因素分析及介入治疗

目的探讨脑动静脉畸形伴发动脉瘤出血风险因素及介入治疗策略。方法收集并整理42例脑动静脉畸形伴发动脉瘤患者的临床和影像学资料。根据患者术中造影结果,分析脑动静脉畸形血管特点,制定相应介入栓塞治疗方案。术后3个月、6个月及1年分别复查DSA,明确病灶有无复发。结果病灶位于幕下、由深静脉引流或混合静脉引流、Spetzler-Martin分级Ⅲ~Ⅳ以及Redekop分型Ⅰ型和Ⅱa型动脉瘤患者易出血。38例介入治疗后经康复治疗后格拉斯哥结果评分4分,1例视力受损,2例有不同程度肢体功能障碍,1例死亡。随访复查37例,均无动静脉畸形复发,且动脉瘤栓塞良好。结论术前明确血管构筑特点及潜在出血风险因素并制定个体化治疗方案,有助于提高介入栓塞治疗脑动静脉畸形伴发动脉瘤的安全性和有效性。     

血管内栓塞治疗脑动静脉畸形

目的探讨血管内治疗脑动静脉畸形的方法。方法采用血管内栓塞过程中注胶（NBCA）及单纯真丝线段作栓塞剂,经股动脉插管通过超选微导管栓塞畸形血管团13例。结果病灶被完全栓塞者1例,栓塞70%以上者3例,栓塞50%～70%者8例,栓塞50%以下者1例。栓塞后有3例表现一过性神经功能障碍。结论血管内栓塞治疗技术为脑动脉脉畸形的治疗展现了较为理想的前景。     

脑膜脑动静脉畸形

作者单位在近六年间共收治脑膜脑动静脉畸形２２例，主要临床症状表现为头痛、头昏、眩晕、恶心、癫痫发作、颅内出血和神经缺失症状等。病变广泛且多位于顶枕部。颈内、颈外动脉同时参与供血。所有病例均行血管内治疗，４例行手术治疗，效果满意。作者认为，对于本病的治疗，较为常用的是血管内栓塞治疗。颈外动脉供血支的栓塞效果较好。     

Location of intracranial aneurysms associated with cerebral arteriovenous malformation: statistical analysis

Distributions of cerebral aneurysms by site were compared statistically in 78 reported cases associated with arteriovenous malformation, including our five cases, and cases with solitary intracranial aneurysms without arteriovenous malformation. When the feeder of an arteriovenous malformation was one of the branches of anterior, middle, or posterior cerebral arteries, the aneurysms were located on these respective arteries much more frequently than expected in the general aneurysmal population. This was statistically significant. Our results strongly suggest that abnormal hemodynamic stresses on the arteries from which the feeders branch out to arteriovenous malformations play a significant role in the development of intracranial aneurysms on these arteries.     

破裂出血的脑动静脉畸形的治疗分析(附42例病例报告)

目的总结单用onyx胶栓塞或结合显微手术治疗以颅内出血为表现的动静脉畸形(AVM)的经验。方法选择2010—2013年临床表现为自发性颅内出血的42例患者,造影明确为脑动静脉畸形,单使用onyx胶栓塞或结合显微手术治疗,进行疗效及并发症分析。结果自发性颅内血肿量较少的I-II级AVM患者中17例仅使用onyx胶栓塞,获得痊愈机会。5例部分栓塞及复查显影的行Y刀治疗。10例颅内血肿量较大,在1~5 d内开颅手术的II-III级AVM患者,术前部分栓塞,降低开颅手术风险。5例IV级AVM,急性期栓塞瘤巢内动脉瘤,降低短期再出血几率,为后期续贯栓塞提供机会。结论对表现为颅内出血的AVM患者,识别血管构筑学特点,并行完全或靶向性栓塞,可获得较好临床疗效。     

Posterior inferior cerebellar artery aneurysm associated with arteriovenous malformation fed by the same artery

A 37-year-old man presented with a peripheral aneurysm of the left posterior inferior cerebellar artery associated with a more peripheral arteriovenous malformation fed by the same artery. Recurrent subarachnoid hemorrhage occurred from rupture of the aneurysm. Review of the pertinent literature indicates that the aneurysm of the posterior inferior cerebellar artery originates from the peripheral portion of the artery, when associated with arteriovenous malformation.     

Cerebral vasospasm with subarachnoid hemorrhage from cerebral arteriovenous malformations

The angiograms and clinical records of 12 patients with subarachnoid hemorrhage from cerebral arteriovenous malformations were reviewed. Of these 12 patients, cerebral vasospasm was confirmed in 1 patient. The case of a 28-year-old man who showed angiographic evidence of cerebral vasospasm is reported, and the rarity of vasospasm associated with subarachnoid hemorrhage from cerebral arteriovenous malformations is discussed.     

Association of cerebral arteriovenous malformation and cerebral aneurysm. Diagnosis and management

Summary Between 1979 and 1989, 7 patients were admitted, with cerebral arteriovenous malformations (AVM) and associated aneurysms (7% of the AVM patients and 2% of the aneurysm patients admitted during the same period). 6 of these patients were admitted because of an intracranial haemorrhage (in 3 of them the AVM, angiographically occult, was discovered at surgery). The last patient was referred for seizures.Preoperatively it was supposed that the haemorrhage was related to the aneurysm in 3 cases, and to the AVM in 3 cases. But surgery allowed one to correct this supposition. Haemorrhage was due to AVM rupture in all 6 cases, and no aneurysm had ruptured. Overall three situations were demonstrated in this series: aneurysm and occult AVM (3 cases); AVM and independent aneurysm in the same area (2 cases); large AVM and aneurysm on a feeding artery (2 cases). All 6 patients admitted for haemorrhage were operated upon, at one operation in 5 of them. Both the malformations were excluded in these six patients. For the patient admitted for seizure, intra-vascular embolization of the AVM was performed, the aneurysm was not treated. The pathogenesis of the association AVM-aneurysm is discussed. In the authors' opinion, haemodynamic relationship should be considered in two cases (large AVM and aneurysm on a feeding vessel). For the other 5 cases, both the AVM and the coexisting aneurysm may be the end-result of a common congenital vascular malformation syndrome.     

Cryptic arteriovenous malformation of the choroid plexus of the third ventricle

A patient with a history of subarachnoid hemorrhage is reported. CT scan evidenced a high-density, round lesion in the anterior part of the third ventricle. A full angiographic study demonstrated no vascular malformation. After removal of a circumscribed hematoma in the anterior part of the third ventricle, an arteriovenous malformation of the choroid plexus was excised.     

Hemodynamics before and after the total removal of a dural arteriovenous malformation of the posterior fossa: Case report

The hemodynamic change before and after the successful total removal of a dural arteriovenous malformation was reported. Preoperative dynamic computed tomography scan showed the prolongation of the cerebral circulation time, and postoperative dynamic computed tomography scan demonstrated improvement of the cerebral hemodynamics, despite total resection of transverse sinus and sigmoid sinus. These findings suggest that, when angiography shows either retrograde venous filling or sinus occlusion, total removal could be done safely.     

Overall results in 304 consecutive patients with acute spontaneous subarachnoid hemorrhage

The results obtained in 304 consecutive patients with spontaneous subarachnoid hemorrhage are described, the majority of whom (86%) were admitted while in acute condition. Only 46% of the patients in this series were in good condition at admission. The initial management was standardized for all patients, but the protocol of "delayed surgery" was applied to patients with subarachnoid hemorrhage from aneurysmal rupture. Two hundred and twenty-two patients (73%) had intracranial aneurysms. Of these, 20 (9%) were moribund and died shortly after admission; nine (4%) underwent emergency surgery due to the coexistence of a life-threatening cerebral hematoma; seven (3%) were operated upon within 3 days of admission; 78 (35%) died after rebleeding or after steady deterioration of the patient's condition due to vasospasm while awaiting surgery. Of the remaining 108 patients ready for delayed surgery, 12 (11%) (operation refused, elderly patients in poor general condition, spontaneous thrombosis of the aneurysm) were treated conservatively, and 96 (89%), who were in various clinical conditions, were actually operated on. Of these 96 patients, 79 (82%) exhibited excellent or good results, 5 (5%) were disabled, and 12 (12%) died. In the authors' experience, the overall management of intracranial aneurysms in unselected patients according to the protocol of delayed surgery results in significant loss of patients awaiting surgery, and good surgical results in the survivors.     

Ruptured supratentorial arteriovenous malformations associated with venous aneurysms

Summary Six patients with ruptured supratentorial arteriovenous malformation (AVM) and an associated venous aneurysm (ectasia, dilatation, varix, pouch) are described.At presentation, patients ranged in age from 16 to 61 years and were equally distributed according to sex. Maximal AVM diameter was between 2.5 and 5.0 cm at presentation while the maximal size of the venous aneurysm ranged between 0.75 and 3.0 cm. One patient had multiple venous pouches while 5 patients had a single venous aneurysm. Three patients had a single bleed; 1 patient had 2 bleeds; and 2 patients had 3 bleeds. Hemorrhage around the venous aneurysm was seen in 4 of 5 patients who underwent magnetic resonance imaging of the brain. One patient, who suffered 3 bleeds over a several year period, had both an increase in the size of the venous aneurysm as well as enlargement of the AVM. The following features did not appear to influence hemorrhage: AVM size or location; venous aneurysm size or location; age; sex; pattern; location or number of draining veins; or external circulation feeders.These observations suggest that a venous aneurysm may increase the risk of hemorrhage from a supratentorial AVM and may be an ominous feature.